Interventional Bronchology Research Articles

4D electromagnetic navigation bronchoscopy for the diagnosis of peripheral pulmonary nodules - An overview and preliminary clinical results

The diagnostic of peripheral pulmonary nodules (PPN) is a particular challenge in interventional bronchology, which is why navigation systems such as electromagnetic navigation (ENB) are increasingly being used. The 4D-ENB represents the most current development of the ENB. It utilizes inspiratory and expiratory CT scans for mapping and thus helps compensate for respiratory movements-induced CT-to-body divergence. The aim of this work was to present the first clinical data and experiences using the 4D-ENB method for diagnosis of PPNs. We retrospectively describe the results of the first nine consecutive patient cases diagnosed at Klinikum Braunschweig using 4D-ENB in a unimodal diagnostic procedure. Of the first 9 PPNs examined by 4D-ENB, navigation and puncture of the lesion was successful in 8 patients (89%). Diagnostic biopsy was could be carried out in six out of nine patients (67%). There were no significant procedure-related complications. Our preliminary data suggest that 4D-ENB is a promising new alternative for the diagnosis of PPNs. To further improve diagnostic yield, 4D-END, which lacks real-time visualization, should be embedded in a multimodal diagnostic procedure with rEBUS and/or fluoroscopy.

Bronchial complications after lung transplantation

Bronchial complications are among the main causes of impairing postoperative period and thansplant failure. Severe bronchial complications are very rare but have a high mortality rate. Light forms decrease transplant function and while progressing can leads to life-threatening conditions without required treatment. Nowadays there is a huge necessity in classification of diagnostic and bronchial complications treatment on different terms after lung transplantation. Methods of observation bronchoscopy and interventional bronchology are allowing us to realize prevention, diagnostic and treatment bronchial complications.

Bronchoscopy in the Czech Republic in the past 45 years and the state in 2020.

To determine the current situation and trends in bronchology in the Czech Republic (CR), a questionnaire survey has been conducted by the Czech Pneumological and Phthisiological Society (CPFS). In 2020, 158 bronchoscopists conducted 26,700 BRS procedures, 927 of them were rigid. 2,869 procedures were done under general anaesthesia. Of diagnostic methods, the use of endobronchial ultrasound (EBUS) is rising, being available in 35 % BRS facilities in 2020. Interventional bronchology procedures are conducted in 17 facilities and 1,517 were executed in 2020. The numbers of cryocauterizations and stenting are growing. In the questionnaire we asked also about biomarkers of lung carcinoma that are examined at 47 out of 49 facilities. Since 1975 when 11,194 bronchoscopies were conducted in the CR, their numbers increased to 33,282 in 2009, then dropping slightly to 26,700 in 2020. At present, 254 bronchoscopies are conducted per 100,000 inhabitants in a year. Based on the BRS survey in 2020 it can be concluded that Czech bronchology is developing in the right direction and is well equipped with both, staff and technical devices. We are adopting new methods without delays and we expand the use of those working well (EBUS) (Tab. 4, Ref. 13).

Tracheobronchial stent sizing and deployment practices airway stenting practices around the world: a survey study.

BackgroundTracheobronchial stents types, uses, techniques for deployment and extraction have practice variations around the world.MethodsWe collected responses by sending an online survey of 8 questions to world interventional bronchology member societies and social media groups.ResultsThere were 269 respondents from 47 countries. Europe had 97 respondents from 22 countries. There were 8 respondents from Australia, 7 from Africa (3 countries) and 7 from 4 countries in South America (SA). North America (NA) had 72 respondents from 3 countries. Asia had 78 respondents from 14 countries. For stent placements 15% [41] used fiberoptic bronchoscope (FB) only. Rigid bronchoscopy (RB) was solely utilized by 38% [102]. Forty-six percent [123] used a combination of RB and FB (P value <0.00001). For stent extraction 13% [19] used FB alone, 57% [85] used RB, and 36% [54] used a combination of RB and FB (P value <0.00001). Placement of stents were 50.5% [135] only by direct visualization. Twenty-three percent [61] always used fluoroscopic guidance. Twenty-six-point-five percent [71] used fluoroscopy in certain cases (P value <0.00001). Sixty percent [162] decided stent sizing by measurements of stenotic and non-stenotic areas on radiology. Twelve percent [32] respondents used sizing devices. Sixty-five percent [177] used a ruler and bronchoscope to measure stenotic areas. Thirty-eight percent [104] used visual estimation and experience. Seven percent [19] used serial balloon dilatation size. To prevent clogging of stents, 22% [59] prescribed mucolytics. Seventy-three percent [195] nebulized saline, 26% [70] had Mucomyst Nebulization, 24% [65] Nebulized bronchodilators and other methods 11% [30] were advised. Covered self-expandable metal stents (SEMS) 44% was the commonest type of stent used around the world. Silicone stents 37%, Y stents 15%, uncovered SEMS 12%, Montgomery T tube 5% followed. Polyflex stents 3% and custom-made stents 3% were least used. Biodegradable stents were used by 7.5%, and not used by 92.5%.ConclusionsTracheobronchial stent practice norms have slowly evolved, but its practice variations lack uniformity, and have sparse evidence-based studies for its direction.

P1.04-015 Clinical Application of Virtual Navigated Bronchial Intervention

Removal of endobronchial tumor is considered the first treatment of choice to improve respiratory status to dilate and maintain the airway. In patients with inoperable tumors we frequently regard endoscopic treatment as the first treatment of choice, but the indications and decisions regarding the method require careful consideration. We reported the indications and efficacy of virtual navigated bronchial intervention for the treatment of bronchial tumors. To select safer and precisely approach for patients with bronchial tumors, we evaluate virtual navigated bronchial intervention using a high-speed 3-dimensional (3D) image analysis system, Synapse Vincent (Fuji Photo Film Co., Ltd., Tokyo, Japan). We set out to clarify, based on retrospective evaluation of routine work-up data in our charts and patient treatment data, the efficacy of virtual navigated bronchial intervention for the treatment of different types of bronchial tumors, yet representative of the spectrum of conditions we encounter, in order to provide a guide to techniques available in interventional bronchology for obstructive lesions. All computed tomography (CT) must satisfy several conditions necessary to analyze images by Synapse Vincent. Synapse Vincent provides more information not only concerning tumor size and shape, but also whether the tumor invades surrounding tissue and the extent of airway and vessel involvement. Constructed images are displayed on a monitor, which can be utilized for deciding the simulation and interventional strategy and for navigation during interventional manipulation. In these cases, Synapse Vincent was used to determine the best planning of virtual navigated bronchial intervention. The feasibility and safety of Synapse Vincent in performing useful preoperative simulation and navigation of interventional procedures lead to the safer, more precise, and less invasive for the patient, and easy to construct an image, depending on the purpose, in 5-10 minutes using Synapse Vincent. Moreover, if the lesion is in the parenchyma or sub-bronchial lumen, it helps to perform simulation with virtual skeletal subtraction to estimate potential lesion movement. By using virtual navigated system for simulation, bronchial intervention was performed with no complications safely and precisely. Preoperative simulation using virtual navigated bronchial intervention reduces the surgeon’s stress levels, particularly when highly skilled techniques are needed to operate on lesions. This task, including interventional simulation and navigation both pre- and during manipulation, could lead to greater safety and precision. These technological instruments should be helpful for bronchial intervention procedures, and are also excellent devices for educational training.

Interventional Bronchology : new insights into old problems

Interventional Bronchology : new insights into old problems

司会のことば(国際シンポジウム "Interventional Bronchology")

司会のことば(国際シンポジウム "Interventional Bronchology")

悪性気道狭窄における Temporary Stenting と Definite Stenting(国際シンポジウム "Interventional Bronchology")

悪性気道狭窄における Temporary Stenting と Definite Stenting(国際シンポジウム "Interventional Bronchology")

Photodynamic Diagnosis and Therapy as Alternative to the Management of Early Stage Lung Cancer(Interventional Bronchology)

Photodynamic Diagnosis and Therapy as Alternative to the Management of Early Stage Lung Cancer(Interventional Bronchology)

Training and practice in bronchoscopy a national survey in Italy.

Bronchoscopy is performed in a variety of different settings in Italy. The surveys conducted so far have highlighted the heterogeneity of the procedures and the frequent inability to adhere to the guidelines. The aim of this survey was to analyse procedures, training, and opinions of Italian respiratory physicians performing interventional bronchology in the clinical practice. The study was conducted retrospectively on 300 pulmonologists. From January to June 2008, these were invited to participate in an email survey to be sent out monthly to each participant for four consecutive months. Two hundred and one respiratory physicians took part in the study, most of whom (83.5%) work in either Pulmonology or Interventional Pulmonology Units. The year before the survey, 21.2% of the participants had performed fewer than 100 examinations, 42.3% 100 to 300, and 36.6% more than 300 bronchoscopies; 53.9% were familiar with the international guidelines on the topic. Among the responders, 34.1% had received less than 6 months training, 55.3% considered further training in rigid bronchoscopy, laser procedures and thoracoscopy, invaluable for their professional activity. Adequate training for transbronchial needle aspirates, was reported by 49.6% of respondents. Our data show that interventional bronchoscopy procedures are regularly performed according to current recommendations by over half of the Italian Pulmonologists participating in our survey. The need for more comprehensive basic education and training was put forward by the majority of physicians.

AB 101. Update on interventional bronchology techniques.

In recent years rapid development of technology led to the increase in number of interventional bronchology techniques available for use in respiratory endoscopy units (REU). Many of techniques are not readily available for routine use in bronchology, however their appliance significantly increases diagnostic and therapeutic efficacy of bronchoscopy. Among diagnostic interventional bronchoscopy techniques recently advanced in REU of the Institute for pulmonary diseases of Vojvodina most facilitating are autofluorescence videobronchoscopy (AFI), narrow band imaging videobronchoscopy (NBI), radial and linear endobronchial ultrasound (EBUS). In recent years REU team published several significant clinical trials in domain of AFI, NBI and EBUS. These techniques became routine diagnostic tools for detection of lung cancer, tuberculosis, sarcoidosis, and other respiratory disorders. Therapeutic interventional bronchoscopy techniques routinely used in treatment of malignant and non-malignant central airway obstruction are Nd:YAG laser resection, argon plasma coagulation, electrocautery, endobronchial brachytherapy, cryotherapy and tracheobronchial stenting. All of the techniques, except of stenting, are readily available for routine use at the REU. Large number of clinical trials in domain of therapeutic interventional pulmonology was in recent years published by the team of REU. Further development and improvement in use of diagnostic and therapeutic interventional pulmonology techniques is required in order to facilitate quality of medical care. Joint clinical trials with partners in EU and other countries would increase the quality of research and publications. Acquisition of more advanced techniques for diagnosis and treatment of respiratory diseases (electromagnetic navigation bronchoscopy, LungPoint virtual bronchoscopic navigation, technology for endobronchial lung volume reduction, bronchial thermoplatsy systems, etc) is one of the priorities of REU team at the Institute for Pulmonary Diseases of Vojvodina.

Interventional management for benign airway tumors in relation to location, size, character and morphology.

To select minimally stressful methods for patients with benign bronchial tumors, and evaluate interventional strategies in relation to location, size, character and morphology. We reviewed the indications and efficacy of various interventional bronchology techniques at our institution, including individual or combined laser resection, electrocautery, argon plasma coagulation and high radiofrequency snaring for the treatment of various types of benign bronchial tumors. It is essential to treat endoscopically that the tumor is visible and has a stalk and not invade beyond bronchial wall. By using combined techniques, no complications or recurrences were encountered. Interventional bronchology techniques for benign bronchial tumors can be simple and safe, and therapeutic strategies should be designed in relation to location, size, character and morphology of tumors.

Is Transcatheter Rescue Management of a Pulmonary Artery Bronchial Fistula Justified?

Endobronchial brachytherapy and interventional bronchology have changed the management of stage 3A (T4N0M0) non-small cell lung carcinoma. We discuss the case of a female patient who developed massive hemoptysis due to a fistula between the left pulmonary artery and stented left main bronchus. Although transcatheter management of the fistula was initially successful, the patient outcome secondary to coronary insult was poor. We present our management dilemma to highlight the need for careful consideration when selecting patients with heavily irradiated chests for endobronchial stenting.

Interventional Bronchology — Laser Photoresection and Stenting for Tracheal Stenosis

Interventional Bronchology — Laser Photoresection and Stenting for Tracheal Stenosis

Intensivmedizin aus Sicht des Thoraxchirurgen

Intensive care in thoracic surgery requires highly specialised abilities and knowledge in addition to usual intensive care standards. The operative chest intensivist must be experienced in special surgical methods, interventional bronchology, and tube management. Cooperating with chest physicians and anaesthesiologists, he takes the central position in intensive therapy. This is described in detail and explained by examples. Furthermore, aspects of education in this specialty will be emphasised.

The Flexible Bronchoscope: Which Hand Should Hold It?

Cultural understanding of left-hand dominance has passed through the millennia as evidence of brain damage to demonic possession. Different cultures and traditions still regard the left hand as unclean. In the last several decades, lefthandedness has been accepted and now only with some biases. The extent to which we are a right-handed society can be noted by paying very close attention to the objects we use everyday. Right now, I am typing this on a standard QWERTY keyboard with the mouse at my right hand. The scroll bar is on the right of my window, and when I fire my semiautomatic pistol, the shell casings are expelled away from my face out of the right side. (I actually do not even know how to shoot a gun, but the example is interesting.) Thus, it seems interesting that the “classic teaching” for bronchoscopy is that it should be held in the left hand. Why? Fortunately, we do not really grapple with this; there is no data supporting a specific technique and expert opinions are varied. There are no studies from other procedures to perform any systematic review so this Mehta-analysis will have to suffice. We have identified several areas of possible debate supporting the rationale for using the flexible bronchoscope (FB) in a specific hand (Table 1). The issues we conclude are related to design, tradition, bronchoscopist–patient anatomic ergonometry, advanced techniques, and motor learning. The following few paragraphs describe these arguments, and perhaps demonstrate that the FB might be poorly designed for the majority of bronchoscopists in the era of interventional bronchoscopy.

The Role of Endobronchial Ultrasound and Self-expanding Metallic Airway Stents(Interventional Bronchology)

The Role of Endobronchial Ultrasound and Self-expanding Metallic Airway Stents(Interventional Bronchology)